Abstract
Background: Despite the fact that hepatitis C virus (HCV) is a relatively common infection in Canada, particularly in British Columbia (BC), there is a paucity of information on actual HCV prevalence in pregnant women. At present, pregnant women are only screened if they fit risk criteria, which may result in under-identification of HCV in this population. The purpose of this study was to determine the overall prevalence rate, age and geographic distribution of reported HCV infection among pregnant women in BC, and compare results to a previously conducted anonymous seroprevalence survey.
Methods: Reported HCV prevalence was determined through a confidential database linkage of all prenatal screening results at the Canadian Blood Services (CBS) with all HCV test results at the Provincial Laboratory, from May 2000 to Oct 2002. Data were stratified by age group and geographic location, and subsequently compared to an anonymous prenatal seroprevalence survey conducted in 1994.
Results: The overall HCV prevalence rate was 50.3/10,000 (95% CI 46.3-54.6), or 0.5% of the cohort. Prevalence was highest in the northern BC region (66.2/10,000, 95% CI 51.4–85.3) and lowest in the populous suburban region southwest of Vancouver (38.0/10,000, 95% CI 32.3–44.8). Of note, the rate of reported HCV among pregnant women was significantly lower than the anonymous seroprevalence rate: 50.3/10,000 vs. 91.3/10,000 (p<0.0001).
Conclusion: Rates of reported HCV among pregnant women were approximately 50% lower than the rates determined by the anonymous seroprevalence survey. Further research is needed to determine the relative merits of the current selective screening policy versus universal prenatal HCV screening in pregnancy.
Key Words: Hepatitis C virus, pregnancy, mother to child transmission, prenatal testing
Résumé
Contexte: Bien que les infections par le virus de l’hépatite C (VHC) soient relativement courantes au Canada, tout particulièrement en Colombie-Britannique (C.-B.), on manque d’information sur la prévalence réelle du VHC chez les femmes enceintes. À l’heure actuelle, les femmes enceintes ne sont dépistées que si elles correspondent aux critères de risques, ce qui peut entraîner une sous-détection du VHC dans cette population. Le but de notre étude était de déterminer le taux de prévalence global, l’âge et la répartition géographique des cas d’infection à VHC déclarés chez les femmes enceintes en C.-B., et de comparer ces résultats à ceux d’une enquête anonyme sur la séroprévalence du VHC menée antérieurement.
Méthode: Nous avons déterminé la prévalence du VHC déclaré par un maillage confidentiel des résultats de dépistage prénatal de la base de données de la Société canadienne du sang avec les résultats des tests de sérodiagnostic du VHC effectués par les laboratoires provinciaux de mai 2000 à octobre 2002. Les données ont été stratifiées selon le groupe d’âge et le lieu géographique, puis comparées à celles d’une enquête anonyme sur la séroprévalence prénatale datant de 1994.
Résultats: Le taux de prévalence global du VHC était de 50,3 p. 10 000 (IC de 95 % = 46,3-54,6), soit 0,5 % de la cohorte. La plus forte prévalence a été observée dans la région Nord de la C.-B. (66,2/10 000, IC de 95 % = 51,4-85,3), et la plus faible dans la populeuse région suburbaine du Sud-Ouest de Vancouver (38/10 000, IC de 95 % = 32,3-44,8). N.B.: Le taux de VHC déclaré chez les femmes enceintes était significativement inférieur au taux de séroprévalence anonyme: 50,3/10 000 contre 91,3/10 000 (p<0,0001).
Conclusion: Les taux de VHC déclaré, chez les femmes enceintes, étaient inférieurs d’environ la moitié aux taux observés dans l’enquête de séroprévalence anonyme. Il faudrait pousser la recherche pour déterminer l’utilité respective de la politique de dépistage sélectif actuellement en vigueur et d’un dépistage prénatal universel du VHC pendant la grossesse.
Mots Clés: hépatite C, grossesse, transmission mère-enfant, dépistage prenatal
Footnotes
Conflict of Interest: None to declare.
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